1. LIVE CASE PRESENTATION MOUNT SINAI CARDIAC CATH LAB
WEDNESDAY, MAY 24, 2017

2. HISTORY OF PRESENT ILLNESS
Patient is an 65 year old male with a history of hypertension and hyperlipidemia
Has a history of peripheral arterial disease s/p right SFA stenting (Supera and Zilver) and right peroneal PTA (2/8/17). Also has had left popliteal stent (Supera) and left peroneal PTA in the past
Presents with severe right lower extremity rest pain (Rutherford Grade 2, Category 4, Fontaine Stage III) over the last 2 weeks
Symptoms have been getting progressively worse
No ischemic ulcers noted

3. Chronic renal insufficiency- Cr 1.8 Peripheral arterial disease
PAST MEDICAL HISTORY
Hypertension
Hyperlipidemia
Chronic renal insufficiency- Cr 1.8
Peripheral arterial disease
Left popliteal – Supera 5.5 x 40 mm stent and left peroneal PTA in the past
Right SFA Stenting (mid SFA- Supera 5.5 x 60mm and distal SFA- Zilver PTX 6 x 120mm) and right peroneal PTA recently (2/8/17)

4. MEDICATIONS
ASA
Clopidogrel
Atorvastatin
Metoprolol
ALLERGIES
NKMA
SOCIAL HISTORY
Smoking: 30 pyh Quit 10 years ago
Alcohol Use: None
Drug Use: None
FAMILY HISTORY
None
ROS
Negative aside from above

5. PHYSICAL EXAMINATION
Vital- BP 130/60 Pulse 70 Resp 14 Afebrile
Neck- No carotid bruits
CV- RRR no murmurs/rubs/gallops
Resp- CTAB
Ext- Diminished doppler right DP and PT pulses. 2+ left DP and PT pulses. No ischemic ulcers.
LABS
HGB 13.0
PLT 200
CR 1.8
INR 1.0
ABI
Right ABI 0.40
VASCULAR ARTERIAL ULTRASOUND
Right SFA 100% occlusion

6. COMPLETION PERIPHERAL ANGIOGRAM 2/8/2017

11. CURRENT PERIPHERAL ANGIOGRAM

19. CASE PRESENTATION SUMMARY
65 year old male with hypertension, hyperlipidemia and PAD s/p recent right SFA stenting (Supera and Zilver) and right peroneal PTA 2/2017. Also has had left popliteal stent (Supera) and left peroneal PTA in the past
Patient presents with right lower extremity rest pain over the last 2 weeks
Abnormal right ABI of 0.40
Peripheral angiogram reveals right ostial SFA occlusion with reconstitution at the popliteal and 1 vessel runoff
Plan: Right SFA intervention
Initial thrombolysis – tPA
Re-evaluation and further intervention